Medicare Votes

110th congress, vote #491; House of Representatives #6331

Medicare Bill

Official Title:To amend titles XVIII and XIX of the Social Security Act to extend expiring provisions under the Medicare Program, to improve beneficiary access to preventive and mental health services, to enhance low-income benefit programs, and to maintain access to care in rural areas, including pharmacy access, and for other purposes.

HR 6331 Medicare BillSenate first passed the legislation, by voice vote 69-30, July 9, 2008. President George W. Bush vetoed the bill, but Senate voted to override his veto, 70-26, July 15, 2008

Synopsis:

This legislation set out to nix a 10.6 percent cut in Medicare payments to doctors scheduled for 2008, and a 5.4 percent reduction scheduled for 2009. Instead, the bill called for a 1.1 percent increase in Medicare reimbursements to physicians. The bill also called for cuts in privately administered Medicare Advantage plans.

Just before the Fourth of July recess, the House passed the by a vote of 355 to 59. But in the Senate, Republicans blocked initial efforts to take up the bill, so the cut to physicians payments were set to take effect July 1, as required by the "sustainable growth rate' (SGR) formula. (For a discussion of the SGR, see "HR 3961 Revising Medicare Physician Fee Schedules" under "House of Representatives.") But the Bush administration delayed processing of new claims from physicians, hoping to give Congress time to come up with a compromise.

But that didn't happen.

Instead, on July 9, Senator Edward Kennedy, who had been absent from Washington for several months while undergoing treatment for brain cancer, showed up to save the day, casting the 60th vote to stop the filibuster. His visit was a surprise, and when he entered the chamber where he had served for nearly 45 years, members of both parties cheered. At that point 9 more Republicans crossed party lines, and HR 6331 was approved 69-30. In total, eighteen Republicans voted for the bill, joining all 49 Democrats and the chamber's two independents.

President George W. Bush, who was opposed to cutting payments to Medicare Advantage insurers then vetoed the legislation./ But on July 15 the House voted to override the veto, 383-41; later in the day, the Senate voted in favor of the bill 70-26.

In addition to blocking a reduction in Medicare reimbursements to physicians while reducing the payments to private insurers, HR 6331 expanded coverage for beneficiaries, increasing benefits for mental health, reducing the beneficiary's co-payment; and lifting assistance for low-income seniors. The legislation also set high standards for the marketing tactics that Medicare Advantage insurers could use.

Why supporters pushed for this bill

House Speaker Nancy Pelosi told the New York Times: "Seniors' organizations and disabilities groups support this legislation. Just about every health-care-providing group in our country supports this legislation, except one, and that is health insurance industry. I guess the president is voting with them and not with America's seniors."

In theory, private sector "Medicare Advantage" plans were supposed to be more efficient than traditional government-run Medicare, but independent studies had reported that the private "Medicare Advantage" plans, sold by insurers like Humana and UnitedHealth, cost the government more per person. This was in part because some offered additional benefits, such as eye care and reduced fees for gym memberships, but the value of the new benefits did not add up to justify the higher payments from Medicare. /li>

The legislation set out to curtail high-pressure Advantage sales tactics that had prompted complaints from beneficiaries and state insurance regulators.

Why opponents tried to stop the bill

In his veto message, President Bush said: "I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong." He argued that cutting federal payments to Medicare Advantage plans would slow the growth of such plans, offered by insurance companies as an alternative to traditional Medicare.

Representative Jim McCrery, Republican of Louisiana, said the bill "just kicks the can down the road, and does not fix fundamental flaws in the formula for paying doctors. In 18 months," Mr. McCrery predicted, "doctors will face a 20 percent cut in their Medicare payments."